# SISSETON WAHPETON OYATE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346734696
- **Authorized official:** MR. EDMUND JOHNSON JR. (SISSETON-WAHPETON OYATE TRIBAL SECR)
- **Authorized official phone:** (605) 698-3911

## Contact information

- **Practice address:** 12554 BIA HWY 711, AGENCY VILLAGE, SD 57262
- **Practice address phone:** (605) 698-3911
- **Practice address fax:** (605) 698-3276
- **Mailing address:** PO BOX 509, AGENCY VILLAGE, SD 57262
- **Mailing address phone:** (605) 698-3911
- **Mailing address fax:** (605) 698-3276

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 172V00000X | Community Health Worker | — | NULL | — |
| 172V00000X | Community Health Worker | — | — | — |
| 251300000X | Local Education Agency (LEA) | — | NULL | — |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | — |
| 253J00000X | Foster Care Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |
| 332U00000X | Home Delivered Meals | — | NULL | — |
| 347C00000X | Private Vehicle | — | NULL | — |

## Other

- **Enumeration date:** 06/20/2018
- **Last updated:** 01/04/2024